Type 2 Diabetes Mellitus

Obese individuals develop insulin resistance, a substance that regulates blood sugar levels. Over time, the resulting high blood sugar content can cause serious damage to the arteries, leading to blockages in the vessels of the heart, kidneys, brain, and extremities.

Osteoarthritis

The additional weight applied to the joints, especially the knees, ankles, hips, and spine, causes rapid wear, accompanied by pain and inflammation, potentially leading to herniated discs and reduced joint mobility.

Obstructive Sleep Apnea and Respiratory Problems with Snoring

Fat deposits in the tongue and neck can cause intermittent obstruction of the airway. Since this obstruction increases when sleeping on the back, you may frequently wake up snoring to reposition yourself in bed. The resulting sleep reduction often causes daytime drowsiness and headaches.

Dyslipidemias

These are a series of disorders in the blood’s fat substances. A common form of dyslipidemia is often referred to as “high cholesterol.” However, dyslipidemia is a term that encompasses all related health problems resulting from having an excess of certain lipids or a deficiency of certain types of them. The danger arises when lipids begin to accumulate in the artery walls, along with platelets and other debris, causing thickening, obstruction, and hardening of the arteries. Some arteries become literally blocked; this condition is called atherosclerosis by doctors. Depending on the site of obstruction, it can result in an infarction of the organ that the artery supplied with oxygen.

Gastroesophageal Reflux and Gastritis

Acids perform their function in the stomach and rarely cause problems when they remain there. When there is acid reflux into the esophagus through a weakened or overloaded valve at the top of the stomach, it causes gastroesophageal reflux, with common symptoms being “heartburn” or pain either behind the chest or “in the pit of the stomach.” Approximately 10% to 15% of patients with sporadic, even benign, heartburn symptoms develop a condition known as Barrett’s esophagus, which consists of a premalignant change in the mucosa or lining of the esophagus and is a cause of esophageal cancer. Additionally, this gastroesophageal reflux can come into contact with the airways (bronchi), causing asthma attacks or bronchospasm.

Gallbladder Diseases

These occur more frequently with obesity, partly due to repeated weight loss efforts (diets), which produce a change in metabolism, predisposing these patients to form gallstones. When these stones form in the gallbladder, they can cause severe abdominal pain, infection, and jaundice (resulting from the accumulation of bilirubin in the body), leading to the need for gallbladder removal.

Cancer

Obesity can increase the likelihood of developing certain types of cancer by 50%. In women, breast, uterine, endometrial, and ovarian cancer. In men, the likelihood of colon and prostate cancer increases.

Infertility Due to Polycystic Ovary Syndrome and Menstrual Cycle Disorders

Women with morbid obesity often experience menstrual cycle disorders, including interruption, abnormal menstrual flow, and increased pain.

Stretch Marks

Skin hygiene can be a serious problem in obese individuals, as friction or rubbing of the skin is very common, potentially causing small abrasions or lesions, leading to fungal (yeast) or bacterial infections. Additionally, darkening and thickening of the skin can occur in the neck, friction sites, and folds (Acanthosis Nigricans), as well as the appearance of warts and skin horns.

Leg Swelling and Skin Ulcers

Leg swelling is common among obese individuals and can be caused by decreased venous return or the formation of blood clots in the leg veins. Without treatment, it can lead to extremely difficult-to-treat leg ulcers.

Stress Urinary Incontinence

A large and heavy abdomen, combined with the relaxation of pelvic muscles, especially associated with the effects of childbirth, can weaken the bladder sphincter or valve, causing urine leakage when coughing, sneezing, or laughing.

Pulmonary Embolism

Pulmonary emboli are clots within the venous circulation of the lungs. Most of these clots form in the lower extremities due to a condition known as Deep Vein Thrombosis (DVT). Since overweight individuals are more susceptible to circulatory problems, their chances of experiencing pulmonary emboli and sudden death are higher.

Psychosocial Issues

Equally important are the psychological, social, and economic problems (work difficulties due to limitations, disability, discrimination at work, airplanes, theaters, etc.). These patients often have a negative self-image, with a tendency to depression, social isolation, sexual problems, divorces, and even suicide. All of this results in a poor quality of life and a high risk of severe complications that compromise life expectancy. Additionally, these individuals with severe overweight conditions face constant emotional shocks, repeated diet failures, desperation from family and friends, mocking smiles, and comments from strangers.

Approach to the Problem

Surgical treatment of obesity is major surgery, not a cosmetic treatment. It does not involve removing fat. Bariatric surgery involves reducing the size of the stomach, associated or not, with a procedure that prevents the absorption of some nutrients laparoscopically. Its practice is increasingly common to treat morbid obesity and is the result of three factors:

1. The current understanding of the significant health risks posed by morbid obesity.
2. The relatively low degree of risks and complications of the procedures compared to not performing the surgery.
3. The inefficiency of non-surgical methods currently used to achieve effective and sustained weight reduction.

Bariatric surgery is indicated for patients between 15 and 65 years of age. Patients with a Body Mass Index (BMI) over 40 are candidates for surgery to improve their quality of life, avoid complications, and prevent premature death. Surgery is also indicated for patients with a BMI between 35 and 40 with comorbidities. Repeated failure with medical treatments and diets is an obvious reason for surgery. Some candidates for surgery are so obese and in such poor health that they need to be hospitalized and treated beforehand to improve their surgical risk.

The option of surgery should be offered to well-informed, motivated patients who fervently desire a change in their weight and lifestyle and have an acceptable surgical risk. The patient must accept lifelong follow-up and monitoring after the operation.

In each case, the risks and benefits of surgery should be evaluated. Above all, surgery should be considered as a method intended to alleviate a debilitating disease. Although the cost of this surgery is not affordable for all patients, it is lower than the risks of obesity and less than the medium and long-term treatment of secondary diseases and their complications with a better quality of life.

Effectiveness of Obesity Surgery

The actual amount of weight a patient loses after the procedure depends on several factors, including age, weight before surgery, the patient’s general health condition, the surgical procedure performed, the patient’s ability to exercise, their commitment to following and maintaining dietary and other follow-up care instructions, the patient’s motivation, and the cooperation of their family, friends, and associates.

In general, success in bariatric surgery is defined as the control or cure of comorbidities, achieving a loss of at least 50% or more of excess weight, and maintaining this level for at least five years. The ideal operation is one in which the excess weight loss is greater than 50%, maintained for more than 5 years, benefiting at least 75% of the patients operated on, allowing for a good quality of life and diet, having no long-term complications, and having a low risk of mortality (<1%) and complications (<10%). Clinical data vary according to each of the different procedures mentioned. Results can also vary according to each surgeon.

Clinical studies reveal that after surgery, most patients lose weight rapidly and continue to do so for 18 to 24 months after the procedure. In the first six months, patients can lose between 30% and 50% of their excess weight, and even 70% to 80% of excess weight 12 months after surgery.

Patients with lower initial BMIs may lose a higher percentage of their excess weight and likely come closer to their ideal body weight. Patients with type 2 diabetes tend to show a lower overall reduction in excess weight than patients without this disease. Surgery has been found to be effective in improving and controlling many obesity-related diseases or health conditions.

A study conducted on 500 patients showed that 96% of certain associated diseases studied (back pain, sleep apnea, hypertension, diabetes, and depression) improved or were cured. For example, many patients with type 2 diabetes, although showing a lower overall reduction in excess weight, resolved their diabetic condition excellently, to the point that their need to continue medication was very mild or disappeared.